Medicaid — Lanton Law Blog

Two pro-pharmacy bills continue to make their way through Congress.

healthcare, insurance, pharmaceuticals, pharmacy, pharmacy benefit managerRon LantonAugust 19, 2023Medicaid, Congress, pharmacy, retail pharmacy, any willing provider

Prescription Digital Therapeutics Bill Introduced in Congress

The Medicaid and CHIP Access to Prescription Digital Therapeutics Act also known as S. 5238 seen here was introduced on December 12, 2022 by Senator Capito (R-WV).

CMS, Congress, Digital Therapeutics, healthcare, HHS, HealthIT, legislation, pharmaceuticalsRon LantonDecember 27, 2022Medicaid and CHIP Access to Prescription Digital Therapeutics Act, digital therapeutics, remote patient therapy, remote patient monitoring, CMS, Medicaid, CHIP, prescription

New Congressional Pharmacy Benefit Manager Bill Aimed at Spread Pricing Reintroduced

According to a December 1, 2021 press release, Representatives Carter (R-GA) and Gonzalez (D-TX) have reintroduced the Drug Price Transparency in Medicaid Act. The legislation “would limit the power of pharmacy benefit managers (PBMs) to artificially spike Medicaid drug prices. The Drug Price Transparency in Medicaid Act bans the use of spread pricing by middlemen (PBMs) in Medicaid managed care. PBMs drive up prescription drug costs without adding any value to the consumer.”

Congress, drug price, healthcare, insurance, pharmaceuticals, pharmacy, pharmacy benefit manager, prescription drug costs, MedicaidRon LantonDecember 2, 2021pharmacy, spread pricing, Medicaid, Drug Price Transparency in Medicaid Act

Administrative Judge Rules Against Washington State’s Pharmacy Reimbursement Plan Violates Medicaid Rules

Last week the National Association of Chain Drug Stores (NACDS), the Washington State Pharmacy Association (WSPA) and the National Community Pharmacists Association (NCPA) celebrated an administrative law judge’s ruling against Washington State that stated Washington’s pharmacy reimbursement plan violated Medicaid’s rules.

CMS, healthcare, HHS, pharmacyRon LantonNovember 29, 2020Medicaid, Washington State, State Plan Amendment, Washington State Pharmacy Association, NCPA, NACDS, CMS

New York Comptroller finds $605 million in unnecessary costs to the Medicaid program

The New York Comptroller recently released the results of an audit titled “Medicaid Program-Cost of Pharmacy Services Under Managed Care.” The audit covered the period January 1, 2016 to December 31, 2019.

healthcare, legislation, Long term care pharmacy, LTC, pharmaceuticals, pharmacy, pharmacy benefit manager, insuranceRon LantonSeptember 24, 2020New York Medicaid, New York Comptroller, Medicaid, MCO, drug formulary, carve out

New Executive Order Aimed at Pharmacy Benefit Managers (PBMs)

The White House has released an Executive Order titled “Executive Order on Lowering Prices for Patients by Eliminating Kickbacks to Middlemen.”

reimbursement, prescription drug costs, pharmacy benefit manager, pharmacy, pharmaceuticals, Medicare Part D, insurance, HHS, life sciences, healthcareRon LantonJuly 27, 2020Executive Order on Lowering Prices for Patients by Eliminating Kickbacks to Middlemen, PBM, Pharmacy Benefit Manager, safe harbor, Medicare D, Medicaid, HHS